Individual
MELANI SIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
131 TUCKER STREET, STE 2, JACKSON, TN 38301
(731) 668-1853
(731) 664-7731
Mailing address
PO BOX 3572, JACKSON, TN 38303-3572
(731) 668-1853
(731) 664-7731
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
121210
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121210
RN
TN
Enumeration date
02/02/2017
Last updated
02/02/2017
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